Though Movember is celebrated in November to raise awareness of prostate cancer, testicular cancer and mental health for men, these issues need to be top-of-mind year-round.  Pat Fulgham, M.D., a urologist on the medical staff and medical director of surgical oncology services at Texas Health Dallas, gave us some tips on how to do just that.

“We advocate that men take control of their own health by living a healthy lifestyle and going to regular doctor visits,” Fulgham says. “Movember kind of brings that to everybody’s mind but it needs to be a year-round pursuit.”

Prostate Cancer

As the second leading cause of cancer-related death among American men, prostate cancer tends to fly under the radar symptom-wise for many men, making regular screening essential to catching it early.

“The thing that most men notice as they get older is they have a little more difficulty emptying their bladder. That’s from a condition called benign prostatic hyperplasia, which means the prostate is getting a little larger and that obstructs the flow of urine,” Fulgham explains. “That is not a symptom of prostate cancer, however. Prostate cancer essentially has no symptoms. That’s one of the things that makes it so insidious as a disease.”

Fulgham notes that there are a few common symptoms that tend to present in rare cases or in late stages, which can include:

• The need to urinate frequently, especially at night, and sometimes urgently
• Difficulty starting or holding back urination
• Weak, dribbling or interrupted flow of urine
• Painful or burning urination
• Difficulty in having an erection
• A decrease in the amount of fluid ejaculated
• Painful ejaculation
• Blood in the urine or semen
• Pressure or pain in the rectum
• Pain or stiffness in the lower back, hips, pelvis or thighs

Remember, these symptoms typically only occur in rare cases and don’t necessarily mean you have cancer. Urinary and sexual issues are common occurrences with aging, but if you experience any of the symptoms above or have concerns, contact your doctor for an evaluation.

There are currently two standard ways to test for prostate cancer: the Prostate Specific Antigen (PSA) blood test and the digital rectal exam. Each should be performed once a year for most men between the ages of 50 and 69.

“A digital rectal exam literally lasts 15 seconds. It’s a bit uncomfortable but not terrible and certainly nothing to be feared,” Fulgham says. “Some people have suggested that the exam doesn’t add a great deal to diagnosing prostate cancer, yet we know from our own patients that up to 20 percent of patients who have prostate cancer had a normal PSA test. So the only way they would’ve been diagnosed is by the finger examination.”

Fulgham adds that if you have a family history of prostate cancer, know you have family members with a BRCA-2 gene mutation, or if you’re African American, you may want to talk to your doctor about being screened earlier or more often.

“If a man has a father who had prostate cancer, his risks are about twice that of the general population. If he’s got two male relatives, such as his father and his brother, who have prostate cancer, his risks are about four times the general population. As it is, 1 in 9 men will get prostate cancer at some point in their lifetime,” Fulgham explains. “Other risk factors include race, with African American men having a much higher risk than any other race.”

Prostate cancer is not known to be associated with certain lifestyle factors, but Fulgham notes that a diet rich in red meat and animal fats, along with metabolic syndrome, tend to increase risks. Fulgham says a simple explanation he repeats to his patients is, “If it’s good for your heart, it is also good for the prevention of prostate cancer.” Eating a healthy, varied diet, exercising regularly and maintaining a healthy weight can help reduce your overall risk.

Testicular Cancer

Testicular cancer is most common in men ages 13 to 20 and 35 to 40-years old. Unlike prostate cancer, testicular does present with a common symptom: a painless lump or mass in the testicle.

“Any change in the scrotum should be evaluated as soon as it is noticed, and men should see their primary care physician, who may refer them to a urologist,” Fulgham explains. “The biggest misunderstanding about testicular cancer is that there are no symptoms until it has progressed to an advanced stage. There is no pain associated with it.”

The good news is that the five-year survival rate is as high as 99 percent when the cancer is still local to the testicles. Those rates drop to 73 percent if cancer has spread to other organs or lymph nodes away from the original tumor, underscoring the importance of early detection.

While some men may not experience any physical symptoms until the cancer is advanced, the most common signs and symptoms of testicular cancer include the following:

• Swelling or a painless lump in one or both testicles
• Pain or discomfort in the testicles or scrotum
• Changes in how the testicles feel
• A dull ache in the groin area or lower abdomen
• A sudden build-up of fluid in the scrotum

If any of these symptoms are present, men should schedule an appointment with their doctors for a physical exam and any necessary diagnostic testing, including ultrasound, blood test for tumor markers, or surgery. While biopsies are common for other types of cancer, testicular biopsy carries a high risk that it could allow cancer to spread to nearby parts of the body. As a result, if testicular cancer is strongly indicated, a surgeon will remove the tumor, testicle and spermatic cord. Testing will then confirm the type and extent of the cancer, which will assist in creating a treatment plan.

Mental Health

Mental health is commonly swept under the rug for many men. While women are statistically more likely to have a serious mental illness (5 percent) than men (3.1 percent), the percentage of men (3.6 percent) with a co-occurring mental illness and substance abuse disorder was higher than that of females (3 percent).

As many as 10 million Americans experience a serious mental illness every year. While more women than men are diagnosed, males (63.6 percent) receive treatment at a lower rate than females (71.6 percent).

Andrew Carlton, a registered nurse and the behavioral health administrator at Texas Health Resources, says recent numbers and research is showing a shift in young men reaching out for help, but that it still remains an issue among older men.

“In the last several years, we’ve seen a significant paradigm shift where mental illness has been brought to the public forefront, and we talk about topics like depression and suicide,” Carlton says. “The younger generation has been brought up in a culture where open and honest communication is the norm, but for men in their mid-30s and up, that just isn’t often done.”

There are also problematic expectations and the unrealistic societal “requirement” that men hide their emotions. A report from the Suicide Prevention Resource Center, or SPRC, also points to cultural expectations about masculine identity, which can reduce the effectiveness of suicide interventions and exacerbate risk factors, including mental disorders, alcohol and drug abuse, lack of access to behavioral health services and access to lethal means.

The expectations especially felt by men in their middle years include the following:

• Being independent and competent (not wanting to seek outside help)
• Concealing emotions (particularly those that signify vulnerability or weakness)
• Finding identity in being the family “breadwinner” (identity is challenged when he can’t provide financially for his family due to a lost job, reduction in pay, etc.)

“Many middle-aged men won’t talk about depression and suicide, so they don’t know what to do when their self-worth takes a big hit due to financial stressors or big relationship changes like a divorce,” Carlton says. “Men were told for decades how they were and weren’t supposed to act in times of crises. Thankfully a lot of that has gone by the wayside, and it’s become more acceptable to admit you are struggling or have a mental disorder. For many years, men just weren’t given the tools to know how to deal with those really hard things.”

The American Psychiatric Association provides the following warning signs of suicide:

• Often talking or writing about death, dying, or suicide
• Making comments about being hopeless, helpless or worthless, or having no reason for living
• Withdrawal from friends, family and community
• Increased alcohol and/or drug misuse
• Reckless behavior or more risky activities, seemingly without thinking
• Dramatic mood changes
• Talking about feeling trapped or being a burden to others
• In some cases, an immediate stressor or sudden catastrophic event, failure or humiliation such as a relationship break-up, legal problems or financial problems (home foreclosure or job loss) can lead to suicide

Texas Health Resources is responding to the need for more behavioral health care in the North Texas area by expanding both inpatient and outpatient facilities. New inpatient hospitals are being built in Corinth and Mansfield, while intensive outpatient program (IOP) facilities are available in Flower Mound and Allen, among others.

If you or someone you know is struggling with depression or other mental health issues, visit Texas Health Behavioral Health or call the help line at 682-549-7934, which is available 24/7.